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Posted: 11-Jun-25
Location: Los Angeles, California
Categories:
Internal Number: 147823428
Take on a significant role within a world-class health organization. Elevate the operational effectiveness of a complex health system. Take your professional expertise to the next level. You can do all this and more at UCLA Health.
As a key member of our Medicare Advantage Operations team, you will develop detailed requirements specifications to meet our business needs. This will involve working directly with and serving as a liaison between business units, external trading partners, IT, and support teams. You will:
- Ensure functional and non-functional requirements are understood and implemented
- Perform testing, design, and delivery requirements
- Identify, analyze, quantify, and mitigate business risks
- Deliver and update training documentation
- Generate ad hoc reports to support the operations team
We’re seeking a self-motivated, adaptable, customer-focused, results-driven individual with:
- Required Bachelor’s degree in business, information systems, healthcare, or a related field
- Five or more years of experience managing enrollment, claims, or encounters in a Medicare or managed care environment required
- Five or more years of experience with CMS processes required
- Computer proficiency with Microsoft Office, SQL, and data visualization tools
- Knowledge of encounter regulatory reporting and compliance requirements
- Experience managing vendors to contractual requirements
- Ability to research and resolve encounter issues
- Understanding of the healthcare model, capitation, and other managed care IPA and provider reimbursement methodologies
- Knowledge of physician/facility billing practices, CPT coding initiatives, ICD-10 coding standards, and revenue and HCPCS coding
- Strong leadership, interpersonal, analytical, problem-solving, and prioritizing skills
- Excellent oral and written communication skills
- Ability to develop, implement, and evaluate methods and systems to improve efficiency
- Ability to work well independently as well as part of a team
UCLA Health is a world-renowned health system with four award-winning hospitals and more than 260 community clinics throughout Southern California. We are also home to the David Geffen School of Medicine, a highly respected leader in the development of breakthrough medical research and outstanding clinical professionals. If you’re looking to experience greater challenge and fulfillment in your career, you can at UCLA Health.
